The Impact of Blood Pressure Variability on Coronary Arterial Lumen Dimensions as Assessed by Optical Coherence Tomography in Patients with ST-Elevation Myocardial Infarction.

MedStar author(s):
Citation: Cardiovascular Revascularization Medicine. 20(9):768-774, 2019 Sep.PMID: 31208837Institution: MedStar Heart & Vascular InstituteDepartment: Medicine/Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Arterial Pressure | *Coronary Vessels/dg [Diagnostic Imaging] | *Coronary Vessels/pp [Physiopathology] | *Hypertension/pp [Physiopathology] | *ST Elevation Myocardial Infarction/dg [Diagnostic Imaging] | *ST Elevation Myocardial Infarction/pp [Physiopathology] | *Tomography, Optical Coherence | Aged | Female | Humans | Hypertension/co [Complications] | Hypertension/di [Diagnosis] | Male | Middle Aged | Percutaneous Coronary Intervention/is [Instrumentation] | Predictive Value of Tests | Risk Factors | ST Elevation Myocardial Infarction/co [Complications] | ST Elevation Myocardial Infarction/th [Therapy] | Stents | Time Factors | Treatment OutcomeYear: 2019ISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: BACKGROUND: Patients with ST-elevation Myocardial Infarction treated by primary percutaneous coronary intervention (PPCI) experience drastic hemodynamic systemic changes (i.e., blood pressure) during the different phases of the procedure. Optical coherence tomography is often used to unveil the underlying cause of STEMI (pre-PCI) and to optimize stent implantation (post-PCI). The impact of blood pressure variability on coronary lumen remains uncertain. This study aimed to investigate the relationship between blood pressure variability, before and after PCI, and coronary arterial lumen dimensions of the infarct-related artery.CONCLUSION: Despite significant hemodynamic variability, the difference in lumen cross-sectional area, between pre- and post-coronary artery stenting was minimal. This study supports the use of OCT lumen areas to inform clinical decisions during PPCI. Copyright (c) 2019 Elsevier Inc. All rights reserved.METHODS: We measured systolic, diastolic and mean arterial blood pressure (SBP, DBP, and MAP; respectively) at pre- and post-PCI. Frequency-domain optical coherence tomography (FD-OCT) imaging was performed at the same time points. Offline quantitative image analyses were performed to assess the average and minimum lumen area (LA). DELTA blood pressure (after and before the PCI) was then calculated.RESULTS: A total of 14 ST-segment elevation myocardial infarction (STEMI) patients were included. 84.2% of enrolled patients were male with a mean age of (58+/-10.7years). Roughly two-thirds (57.8%) had hypertension. The mean SBP was (112.6mmHg+/-16.1) and (117.2mmHg+/-20.9), pre- and post-stenting, respectively; the range of the observed SBP differences (between pre- and post-PCI) went from -25 to +23mmHg. Pre- and post-stenting mean average LA were (7.1+/-2.5mm2 and 6.8+/-2.3mm2; respectively). There were poor correlations between DELTASBP and DELTA mean minimum LA. A similar pattern was observed with DELTADBP and DELTAMAP.All authors: Banning AP, Benenati S, Channon KM, De Maria GL, Dijkstra J, Garcia-Garcia HM, Hideo-Kajita A, Kuku K, Oxford Acute Myocardial Infarction (OxAMI) Study investigators, Ozaki Y, Soud M, Tariq MAOriginally published: Cardiovascular Revascularization Medicine. 20(9):768-774, 2019 Sep.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-10-14
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Journal Article MedStar Authors Catalog Article 31208837 Available 31208837

BACKGROUND: Patients with ST-elevation Myocardial Infarction treated by primary percutaneous coronary intervention (PPCI) experience drastic hemodynamic systemic changes (i.e., blood pressure) during the different phases of the procedure. Optical coherence tomography is often used to unveil the underlying cause of STEMI (pre-PCI) and to optimize stent implantation (post-PCI). The impact of blood pressure variability on coronary lumen remains uncertain. This study aimed to investigate the relationship between blood pressure variability, before and after PCI, and coronary arterial lumen dimensions of the infarct-related artery.

CONCLUSION: Despite significant hemodynamic variability, the difference in lumen cross-sectional area, between pre- and post-coronary artery stenting was minimal. This study supports the use of OCT lumen areas to inform clinical decisions during PPCI. Copyright (c) 2019 Elsevier Inc. All rights reserved.

METHODS: We measured systolic, diastolic and mean arterial blood pressure (SBP, DBP, and MAP; respectively) at pre- and post-PCI. Frequency-domain optical coherence tomography (FD-OCT) imaging was performed at the same time points. Offline quantitative image analyses were performed to assess the average and minimum lumen area (LA). DELTA blood pressure (after and before the PCI) was then calculated.

RESULTS: A total of 14 ST-segment elevation myocardial infarction (STEMI) patients were included. 84.2% of enrolled patients were male with a mean age of (58+/-10.7years). Roughly two-thirds (57.8%) had hypertension. The mean SBP was (112.6mmHg+/-16.1) and (117.2mmHg+/-20.9), pre- and post-stenting, respectively; the range of the observed SBP differences (between pre- and post-PCI) went from -25 to +23mmHg. Pre- and post-stenting mean average LA were (7.1+/-2.5mm2 and 6.8+/-2.3mm2; respectively). There were poor correlations between DELTASBP and DELTA mean minimum LA. A similar pattern was observed with DELTADBP and DELTAMAP.

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